RESUMO
We report a case of nocardiosis in a patient with several risk factors for this rare infection. Radiologically, the patient's multiple lung abscesses were misinterpreted as pulmonary metastases. Diagnosis was finally reached by the growth of Nocardia asteroides in two different blood culture sets. Nocardia bacteraemia is a rare clinical event. Despite initiation of an effective antibiotic therapy, the patient died. Autopsy revealed disseminated nocardial abscesses in the lungs, the kidneys and the brain.
Assuntos
Abscesso/diagnóstico , Bacteriemia/diagnóstico , Abscesso Encefálico/diagnóstico , Nefropatias/diagnóstico , Abscesso Pulmonar/diagnóstico , Nocardiose/diagnóstico , Nocardia asteroides , Infecções Oportunistas/diagnóstico , Pneumonia Bacteriana/diagnóstico , Abscesso/tratamento farmacológico , Abscesso/patologia , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/patologia , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/patologia , Diagnóstico Diferencial , Quimioterapia Combinada , Evolução Fatal , Humanos , Nefropatias/tratamento farmacológico , Nefropatias/patologia , Neoplasias Laríngeas/cirurgia , Neoplasias Hepáticas/cirurgia , Pulmão/patologia , Abscesso Pulmonar/tratamento farmacológico , Abscesso Pulmonar/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/cirurgia , Nocardiose/tratamento farmacológico , Nocardiose/patologia , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/patologia , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
(1) Background: The pathological tumor response of the primary tumor to induction chemotherapy in synchronously metastasized colorectal cancer (mCRC) patients has not been investigated. The aim of this study was to compare patients treated with induction chemotherapy combined with vascular endothelial growth factor (VEGF) or with epidermal growth factor receptor (EGFR) antibodies. (2) Methods: We present a retrospective analysis, where we included 60 consecutive patients with potentially resectable synchronous mCRC who received induction chemotherapy combined with either VEGF or EGFR antibodies. The primary endpoint of this study was the regression of the primary tumor, which was assessed by the application of the histological regression score according to Rödel. The secondary endpoints were recurrence-free survival (RFS) and overall survival (OS). (3) Results: A significantly better pathological response and a longer RFS for patients treated with the VEGF antibody therapy compared to those treated with the EGFR antibodies was demonstrated (p = 0.005 for the primary tumor and log-rank = 0.047 for RFS). The overall survival did not differ. The trial was registered with clinicaltrial.gov, number NCT05172635. (4) Conclusion: Induction chemotherapy combined with a VEGF antibody revealed a better pathological response of the primary tumor, leading to a better RFS compared to that with EGFR therapy; this has clinical relevance in patients with potentially resectable synchronously mCRC.